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General NPI Number Information
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NPI Number | 1487055232
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Entity Type | Organization
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Legal Business Name | SORENSEN, SMITH, & BAY LLC
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 430 SE MILL ST
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City | MAYO
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State | FL
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Zip | 32066-4804
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Country | US
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Telephone | 386-294-2273
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Fax | 386-294-2289
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Provider Business Mailing Address
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Address Line | 430 SE MILL ST
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City | MAYO
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State | FL
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Zip | 32066-4804
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Country | US
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Telephone | 386-294-2273
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Fax | 386-294-2289
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. MICHAEL J BAY
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Credential |
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Telephone | 386-294-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12528
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License Number State | FL
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